NCG550283_Compliance Evaluation Inspection_20141001

A7,74,
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, Ill
Governor Secretary
October 1, 2014
Jeffrey Brown
122 Rockford Road
Kernersville, NC 27284
Subject: Compliance Evaluation Inspection RECEIVEDlDENR1DWR
Permittee: Jeffrey Brown, Owner
Facility: 122 Rockford Road, Kernersville, NC 27284 OCT 0 3 2014
Permit: NCG550000 General Wastewater Permit
Certificate of Coverage: NCG550283 Water Quality
Forsyth County Permitting Section
Dear Mr. Brown:
1. Ron Boone, of the Winston Salem Regional Office (WSRO) of the NC Division of Water Resources
(DWR or the Division), conducted a compliance evaluation inspection of the single family wastewater
system at your place of residence on September 30, 2014. You were not home for the inspection.
2. The State requires the Division to inspect these types of systems every five years. Yours was last
inspected on 7/15/2009.
3. The wastewater system at your residence appears to operating properly. Mr. Boone found no
discrepancies or problems that indicated anything was wrong. However, the chlorinator and the end of
the pipe could not be found, and therefore a full inspection could not be conducted.
4. Please contact us at the numbers below to schedule a full inspection with Mr. Boone. These types of
systems should be inspected at least every five years to ensure they're properly operated and
maintained. Failure to do so can result in expensive repair costs as well as failure of the system to
properly treat the wastewater. Also, you need to have your septic tank pumped once every three to five
years, depending on usage.
•
585 Waughtown Street,Winston-Salem,North Carolina 27107
Phone:[phone] Internet:www,ncdenr.gov
An Equal Opportunity\Affirmative Action Employer—Made in part by recycled paper

5. If you have any questions regarding this letter or the NCG550000 general permit, please don't hesitate
to contact us at 336-771-5000.
Sincerely,
1
W. Corey Basinger
Regional Supervisor
Water Quality Regional Operations
Division of Water Resources
Attachments:
Inspection Report
CC: WSRO Files
tpentraliFiles)
NPDES Unit

y
•
United States Environmental Protection Agency Form Approved.
EPA Washington,D.C.20460 OMB No.2040-0057
Water Compliance Inspection Report Approval expires 8-31-98
Section A:National Data System Coding(i.e.,PCS)
Transaction Code NPDES yr/mo/day Inspection'Type Inspector Fac Type
1 IN I 2 IS I 3 I NCG550283 111 12 I 14/09/30 117 18 I�.I 19 Li I 20I
21I l l l l I l l l l li l l l l l l l l l l l l i l l l i l l I l I l lI l i l I I 166
Inspection Work Days Facility Self-Monitoring Evaluation Rating B1 QA Reserved ---
671 l 701 l 71 l l 72 I N I 73l I I74 75I I I I I I I l80
Section B:Facility Data LJ
Name and Location of Facility Inspected(For Industrial Users discharging to POTW,also include Entry Time/Date Permit Effective Date
POTW name and NPDES permit Number) 11:45AM 14/09/30 13/08/01
122 Rockford Road -
Exit Time/Date Permit Expiration Date
122 Rockford Rd
12:00PM 14/09/30 18/07/31
Kernersville NC 27284
Name(s)of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s) Other Facility Data
///
Name,Address of Responsible Official/Title/Phone and Fax Number
Contacted
Jeffrey Brown,122 Rockford Rd Kernersville NC 27284///
No
Section C:Areas Evaluated During Inspection(Check only those areas evaluated)
II Other
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
•
Name(s)and Signature(s)of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Ron Boone {1 WSRO WQ//336-771-4967/ /./ri
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date •
irket t•. K! i w /v/o/o/ SL
EPA Form 3560-3(Rev 9-94)Previous editions are obsolete.
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NPDES yr/mo/day Inspection Type 1
3I NCG550283 I'1 121 14/09/30 117 18 u
Section D:Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary)
Please refer to the attached inspection summary letter.
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Permit: NCG550283 Owner-Facility: 122 Rockford Road
Inspection Date: 09/30/2014 Inspection Type: Compliance Evaluation
Other Yes No NA NE
Comment: Owner not home for inspection. A full inspection could not be performed.
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